check your understanding chp 10,11,13,14,15 pathophysio
Vaccination for pneumococcal pneumonia should be performed before 1 year of age in patients with sickle cell anemia. A. True B. False
False Vaccination for pneumococcal pneumonia should be performed before 2 years of age in patients with sickle cell anemia and booster vaccinations given 3 to 5 years later.
Which disorder is considered a primary immunodeficiency disease? A. HIV/AIDS B. Malnutrition immunodeficiency C. Cancer immunodeficiency D. Radiation immunodeficiency
HIV/AIDS HIV/AIDS is a primary immunodeficiency disease involving destruction of T helper cells. Malnutrition immunodeficiency is a secondary immunodeficiency disorder and leads to T-cell destruction and dysfunction. Cancer immunodeficiency is a secondary immunodeficiency disorder caused by the destruction of rapidly proliferating cells from chemotherapeutic agents. Radiation immunodeficiency is a secondary immunodeficiency disorder caused by the destruction of rapidly proliferating cells from the effects of radiation.
While in the hospital for management of acute lymphoid leukemia (ALL), a patient develops severe thrombocytopenia. The most appropriate action for this condition is A. anticoagulant therapy. B. chemotherapy. C. activity restriction. D. isolation.
activity restriction. Thrombocytopenia can produce a life-threatening hemorrhage. Patients with this condition should be protected from trauma and placed on activity restriction to reduce the risk of bleeding.
A newborn has melena, bleeding from the umbilicus, and hematuria. The newborn most likely experiencing A. vitamin K deficiency bleeding. B. acquired vitamin K deficiency. C. von Willebrand disease. D. disseminated intravascular coagulation.
vitamin K deficiency bleeding. Vitamin K deficiency bleeding is found in newborns and includes melena, bleeding from the umbilicus, and hematuria. Acquired vitamin K deficiency may include gastrointestinal bleeding, ecchymoses, menorrhagia, and hematuria. von Willebrand disease presents as epistaxis, mucosal bleeding, ecchymoses, gastrointestinal bleeding, and menorrhagia. Disseminated intravascular coagulation includes bleeding from orifices, petechiae, and ecchymoses on skin and mucous membranes.
Tissues are able to autoregulate their rate of blood flow by controlling A. perfusion pressure. B. arterial blood pressure. C. vascular resistance. D. venous return to the heart.
vascular resistance. Systemic vascular resistance is used to determine the resistance of vessels, diseases, or drug therapies that affect vessels. Any condition that increases vascular resistance requires more work for the heart to overcome the resistance and eject blood volume.
The arterial oxygen content (CaO2) for a patient with PaO2 100 mm Hg, SaO2 95%, and hemoglobin 15 g/dL is _____ mL oxygen/dL. A. 19.4 B. 1909.8 C. 210 D. 21.05
19.4 A hemoglobin level of 15 divided by 100 equals 0.15. Multiply by 1.34 mL and then multiply by saturation on 95%. The result is 19.1% oxyhemoglobin. Then add 0.3% volume dissolved in plasma to get the total content of oxygen/dL.
Which type of leukemia primarily affects children? A. ALL (acute lymphoid leukemia) B. CLL (chronic lymphoid leukemia) C. AML (acute myeloid leukemia) D. CML (chronic myeloid leukemia)
ALL (acute lymphoid leukemia) ALL is primarily a disorder of children. The peak incidence occurs between the ages of 3 and 7 years. The average age of patients with CLL is about 65 to 70 years. The median age of presentation of AML is 64 years. Average onset of CML is between 40 and 50 years.
In general, the best prognosis for long-term disease-free survival occurs with A. ALL (acute lymphoid leukemia). B. CLL (chronic lymphoid leukemia). C. AML (acute myeloid leukemia). D. CML (chronic myeloid leukemia).
ALL (acute lymphoid leukemia). ALL is highly curable in the pediatric population with an 85% survival rate in children. The average age of patients with CLL is 65 to 70 years. Median survival rate is less than 8 years. Patients younger than age 60 have a 4-year survival rate of 30% to 40% in AML. CML does not respond well to chemotherapy and carries a long-term survival rate of 50% to 60%.
Which clinical finding is indicative of compartment syndrome? A. Peripheral edema B. Absent peripheral pulses C. Redness and swelling D. Atrophy of distal tissues
Absent peripheral pulses
A diagnostic laboratory finding in myeloma is A. Bence Jones proteins in the urine. B. decreased platelet count. C. increased IgM antibody titer. D. elevated blood glucose levels.
Bence Jones proteins in the urine. Bence Jones protein in the urine is a common clinical manifestation of plasma cell myeloma. It is also known to accumulate in the kidneys and cause kidney damage.
The principle Ig mediator of type I hypersensitivity reactions is A. IgA. B. IgG. C. IgM. D. IgE.
IgE Immunoglobulin E (IgE) is the principal antibody mediating type I hypersensitivity reactions. IgA is not the primary Ig mediator of type I hypersensitivity reactions. IgG is involved in type II hypersensitivity reactions. IgM is involved in type II hypersensitivity reactions.
What is necessary for red blood cell production? A. Phosphate B. Iron C. Magnesium D. Calcium Immature red blood cells produce hemoglobin, which is composed of two pairs of polypeptide chains, the globins. Each globin has an attached heme molecule that contains iron. Dietary iron is transported through the plasma on the RBC membrane. Phosphates are not a necessary component of red blood cell production. Magnesium is not a part of the production of red blood cells. Calcium is not involved in red blood cell production.
Iron Immature red blood cells produce hemoglobin, which is composed of two pairs of polypeptide chains, the globins. Each globin has an attached heme molecule that contains iron. Dietary iron is transported through the plasma on the RBC membrane. Phosphates are not a necessary component of red blood cell production. Magnesium is not a part of the production of red blood cells. Calcium is not involved in red blood cell production.
Which is not a manifestation of acute arterial obstruction? A. Pain B. Purpura C. Pallor D. Pulselessness
Purpura Purpura is purple-colored spots on the skin, which are not a manifestation of acute arterial obstruction.
A low mean corpuscular hemoglobin concentration (MCHC) and mean corpuscular volume (MCV) are characteristic of which type of anemia? A. Vitamin B12 deficiency B. Folate deficiency C. Iron deficiency D. Erythropoietin deficiency
Iron deficiency Iron-deficiency anemia is characterized by a low hemoglobin concentration and low mean corpuscular volume. Vitamin B12 deficiency anemia is characterized by a high concentration of MCV and a normal level of MCHC. Folate deficiency anemia is characterized by a normal mean corpuscular hemoglobin concentration and a high mean corpuscular volume. Erythropoietin deficiency creates hypoxia from a low hemoglobin level.
Which characteristic is indicative of hemolytic anemia? A. Increased total iron-binding capacity B. Increased heart rate C. Hypovolemia D. Jaundice
Jaundice Jaundice is a classic clinical manifestation of hemolytic anemia. The total iron-binding capacity in hemolytic anemia is not increased. Hemolytic anemia is not generally associated with an increased heart rate unless there is aplastic crisis associated with infection. Hypovolemia is not an indication of hemolytic anemia.
Dysfunction of which organ would lead to clotting factor deficiency? A. Liver B. Kidney C. Spleen D. Pancreas
Liver The liver is responsible for the synthesis of coagulation factors. A clotting factor deficiency is the result of liver dysfunction. Coagulation does not occur in the kidneys. About 25% of the total number of platelets can be found in the spleen. The pancreas is not a location where coagulation occurs.
Which group of clinical findings describes the typical presentation of ALL (acute lymphoid leukemia)? A. Pain in long bones, infection, fever, bruising B. Vertebral fracture, hypercalcemia, bone pain C. Elevated WBC count found on routine examination, asymptomatic D. Painless enlarged cervical lymph node, fever, weight loss
Pain in long bones, infection, fever, bruising The onset of symptoms of ALL is abrupt and may begin when a child refuses to walk or begins to exhibit loss of appetite, fatigue, or abdominal pain. Bruising, fever, and infection are also common early findings.
Which disorder is associated with a type III hypersensitivity mechanism of injury? A. Systemic lupus erythematosus B. Graves disease C. Erythroblastosis fetalis D. Seasonal allergic rhinitis
Systemic lupus erythematosus - Systemic lupus erythematosus is a type III hypersensitivity disorder. Type III hypersensitivity is characterized by antigen-antibody complex deposition into tissues, with consequent activation of complement and a subsequent self-sustaining inflammatory reaction Graves disease and erythroblastosis fetalis are type II hypersensitivity reactions. Seasonal allergic rhinitis is a type I hypersensitivity reaction.
Which is not considered to be a risk factor for thrombus formation? A. Thrombocytopenia B. Vascular trauma C. Stasis of blood flow D. Circulatory shock
Thrombocytopenia Thrombocytopenia is not involved in the development of thrombi. Thrombi may form in the chambers of the heart following a myocardial infarction or damage to the heart valves.
Hemophilia B is also known as Christmas disease. A. True B. False
True Hemophilia B is also known as Christmas disease.
The anemia resulting from a deficiency of either vitamin B12 (cobalamin) or folate is caused by a disruption in DNA synthesis of the blast cells in the bone marrow that produces very large abnormal bone marrow cells called megaloblasts. A. True B. False
True Megaloblasts are large abnormal bone marrow cells
The liver is responsible for the synthesis of coagulation factors, with the exception of part of VIII. A. True B. False
True The liver is responsible for the synthesis of coagulation factors, with the exception of part of factor VI
Widespread activation of the clotting cascade secondary to massive trauma is called A. hemophilia B. B. disseminated intravascular coagulation (DIC). C. Hageman disease. D. idiopathic thrombocytopenia purpura.
disseminated intravascular coagulation (DIC). Widespread clotting in small vessels leads to consumption of the clotting factors and platelets, which in turn leads to bleeding. DIC is either acute or chronic and occurs secondary to malignancy, sepsis, snake bites, trauma, shock, burns, and many other factors. Hemophilia B results from factor deficiency or the abnormal function of factor IX. Massive trauma is unrelated to the development of Hageman disease. Immune thrombocytopenia, formerly called idiopathic thrombocytopenia purpura, is an acquired immune-mediated disorder.
Patients who experience anemic episodes when exposed to certain drugs most likely have A. thalassemia. B. spherocytosis. C. sickle cell anemia. D. glucose-6-phosphate dehydrogenase deficiency.
glucose-6-phosphate dehydrogenase deficiency. Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a RBC intracellular defect. Usually this anemia is first recognized during or after an infectious illness or exposure to certain drugs. Thalassemia does not carry a manifestation associated with pharmacologic agents. Spherocytosis is a hereditary anemia with manifestations of jaundice. Episodes of sickle cell anemia are associated with recurrent painful episodes related to organ dysfunction.
An important mediator of a type I hypersensitivity reaction is A. complement. B. antigen-antibody immune complexes. C. T cells. D. histamine.
histamine. Histamine mediates type I hypersensitivity reactions. Complement mediates type II hypersensitivity reactions. Antigen-antibody immune complexes mediate type III hypersensitivity reactions. T cells mediate type IV hypersensitivity reactions.
Risk factors for atherosclerosis include A. female gender. B. hyperlipidemia. C. high-protein diet. D. low-fiber diet.
hyperlipidemia Hyperlipidemia is a modifiable risk factor associated with atherosclerosis. Men have a higher incidence of atherosclerosis earlier in life than women.
The effects of histamine release include A. vasoconstriction. B. bronchodilation. C. increased vascular permeability. D. decreased gut permeability.
increased vascular permeability. Histamine release leads to increased vascular permeability, which fosters fluid movement out of capillaries and into tissues leading to the edema common in type I hypersensitivity. Histamine leads to bronchoconstriction, increased gut permeability, and vasodilation (not vasoconstriction).
Venous obstruction leads to edema because it ________ pressure. A. increases capillary oncotic B. increases arterial blood C. decreases tissue D. increases capillary hydrostatic
increases capillary hydrostatic Increased fluid accumulation in the interstitial space also occurs when the lymphatic flow is impaired or when capillaries become more permeable and "leak" fluid. These pressure gradients lead to edema. Interstitial fluid colloid osmotic pressure increases play a role in edema. Arterial blood pressure does not lead to edema. Decreased tissue pressure does not lead to edema in venous obstruction.
Disseminated intravascular coagulation may be treated with heparin therapy to A. enhance fibrinolysis. B. Inhibit clotting factor consumption. C. activate platelets. D. enhance liver synthesis of clotting factors.
inhibit clotting factor consumption. Although controversial, heparin may be used to minimize further consumption of clotting factors.
Thalassemia may be confused with iron-deficiency anemia, because they are both A. hyperchromic. B. microcytic. C. genetic. D. responsive to iron therapy.
microcytic. Both thalassemia and iron-deficiency anemia reveal hypochromic, microcytic red cells. Thalassemia and iron-deficiency red cells are hypochromic. Genetics play a role in thalassemia, and are found primarily in Asian individuals. Iron-deficiency anemia is responsive to iron therapy, but thalassemia patients have increased iron absorption.
The strength of the bond between oxygen and hemoglobin is known as the A. Bohr effect. B. oxygen-hemoglobin affinity. C. dissociation curve. D. hemoglobin synthesis.
oxygen-hemoglobin affinity. The strength of the bond between oxygen and hemoglobin is called the oxygen-hemoglobin affinity. Hemoglobin saturation is higher when oxygen infinity is increased, and saturation is lower when affinity is decreased. The Bohr effect occurs when the oxyhemoglobin dissociation curve experiences a shift resulting from changes in PCO2 and H+ concentration. The dissociation curve describes the relationship between the partial pressure of oxygen and hemoglobin saturation. Hemoglobin synthesis occurs in the immature red cell.
A deficiency of von Willebrand factor impairs A. activation of the coagulation cascade. B. platelet aggregation. C. platelet adhesion to injured tissue. D. platelet production.
platelet adhesion to injured tissue. Absence of platelet adhesion at the site of vascular injury and deficient factor VIII activity in the intrinsic coagulation pathway contribute to the bleeding seen in von Willebrand disease. The coagulation cascade is not activated by a deficiency of von Willebrand factor. Platelet aggregation is not related to a deficiency of the von Willebrand factor. von Willebrand factor is necessary for normal adherence of platelets for damaged vascular endothelium.
The megakaryocyte is a precursor to A. factor IX. B. white blood cells. C. red blood cells. D. platelets.
platelets. Platelets are produced by bone marrow megakaryocytes. Production falls when the number of megakaryocytes is reduced or when the process of platelet production is ineffective. One major role in the formation of factor IX is the presence of calcium. White blood cells are not formed in response to megakaryocytes. Megakaryocytes are not a precursor to red blood cells.
Transfusion reactions involve RBC destruction caused by A. donor antigens. B. recipient antibodies C. donor T cells. D. recipient T cells.
recipient antibodies The recipient antibodies of the blood transfusion has antibodies to the donor's red blood cell (RBC) antigens; the antibodies destroy large numbers of RBC. Donor antigens, donor T, and recipient T cells do not cause transfusion reactions.
The movement of blood through the vascular system is opposed by the force of A. viscosity. B. the vessel length. C. the vessel radius. D. resistance.
resistance. The movement of blood through the vascular system is opposed by the force of resistance. Three determinants of resistance are vessel length, vessel radius, and blood viscosity. Viscosity is the thickness of fluid and has an effect on resistance. The length of the vessel does have an effect on the resistance. Vessel radius has an effect on resistance.
The most common primary immune deficiency that affects only B cells is A. DiGeorge. B. Bruton agammaglobulinemia. C. Wiskott-Aldrich. D. selective IgA.
selective IgA. The most common B-cell primary immunodeficiency disorder is selective IgA deficiency. This disorder affects 1:2000 persons. DiGeorge is a T-cell primary immune deficiency. Bruton agammaglobulinemia is not the most common primary immune deficiency affecting B cells; frequency of disease is 1:250,000 males. Females are carriers. Wiskott-Aldrich affects both T cells and B cells.
A patient is diagnosed with a tortuous blood vessel of the right hand that bleeds spontaneously. This patient presents with A. petechiae. B. purpura. C. telangiectasia. D. thrombocytosis.
telangiectasia. A telangiectasia is a dilated or tortuous small blood vessel found in the skin or mucous membranes that have a tendency to bleed spontaneously or following minor trauma. Petechiae are pinpoint hemorrhages. Purpura is a collection of petechiae. Thrombocytosis is a platelet count above 400,000/mm3.
Blood flow throughout the periphery is regulated by A. cardiac output. B. the autonomic nervous system. C. velocity. D. hemodynamics.
the autonomic nervous system. Blood flow throughout the periphery is controlled by central mechanisms that are mediated by the autonomic nervous system, the venous and thoracic pumps, and intrinsic autoregulatory mechanisms.
Activation of the extrinsic pathway of coagulation is initiated by A. platelet factors. B. collagen exposure. C. tissue thromboplastin. D. factor VII.
tissue thromboplastin. The extrinsic pathway of coagulation begins when the vascular wall is traumatized. Tissue factor from injured tissue activates factors which in turn activate and convert into thrombin for clotting
When systemic vascular resistance is decreased, blood flow A. increases. B. decreases. C. stays the same. D. moves to the extremities.
decreases. When SVR is pathologically decreased, the blood is spread over a larger area and blood flow slows dramatically. Individual organs, such as the kidney and brain, may not obtain sufficient blood flow to meet metabolic needs. Blood flow decreases in response to decreases in vascular resistance. When SVR is pathologically decreased, the blood is spread over a larger area and blood flow slows dramatically. Individual organs, such as the kidney and brain, may not obtain sufficient blood flow to meet metabolic needs. Blood flow is not diverted to the extremities when systemic vascular resistance is decreased. However, the vital organs may not have sufficient blood flow to maintain metabolic needs.
